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Elderly patients
cared for by younger
physicians have lower
mortality rates
BMJ: British Medical Journal
Take-home message
•
The purpose of this observational study was to investigate whether
physician age influences outcomes in hospitalized patients. The
investigators examined data from 736,537 admissions between 2011
and 2014 for Medicare beneficiaries ≥65 years; patient care was
managed by 18,854 hospitalist physicians. Adjusted 30-day mortality
rates were lower in patients cared for by physicians under 40 years
of age (10.8%), and increased step-wise as physician age increased:
11.1%mortality ratewhen the physician was 40 to 49 years, 11.3%when
the physician was 50 to 59 years, and 12.1% when the physician was
≥60 years. Importantly, there was no association between age of a
physician and 30-day mortality when a physician cared for a high
volume of patients. Cost of medical care was slightly higher with
older physicians, but readmission rates were not associated with
physician age.
•
The authors conclude that elderly patients cared for by younger
physicians have a lower mortality rate than patients cared for by
older physicians, but this mortality difference is not present if the
physician cares for a high volume of patients.
Abstract
OBJECTIVES
To investigate whether outcomes of patients who were admitted to
hospital differ between those treated by younger and older physicians.
DESIGN
Observational study.
SETTING
US acute care hospitals.
PARTICIPANTS
20% random sample of Medicare fee-for-service beneficiaries
aged ≥65 admitted to hospital with a medical condition in 2011-14 and treated
by hospitalist physicians to whom they were assigned based on scheduled work
shifts. To assess the generalizability of findings, analyses also included patients
treated by general internists including both hospitalists and non-hospitalists.
MAIN OUTCOME MEASURES
30 day mortality and readmissions and costs of care.
RESULTS
736537 admissions managed by 18854 hospitalist physicians (median
age 41) were included. Patients’ characteristics were similar across physician
ages. After adjustment for characteristics of patients and physicians and hospital
fixed effects (effectively comparing physicians within the same hospital), patients’
adjusted 30 day mortality rates were 10.8% for physicians aged <40 (95% con-
fidence interval 10.7% to 10.9%), 11.1% for physicians aged 40–49 (11.0% to 11.3%),
11.3% for physicians aged 50–59 (11.1% to 11.5%), and 12.1% for physicians aged ≥60
(11.6% to 12.5%). Among physicians with a high volume of patients, however, there
was no association between physician age and patient mortality. Readmissions
did not vary with physician age, while costs of care were slightly higher among
older physicians. Similar patterns were observed among general internists and
in several sensitivity analyses.
CONCLUSIONS
Within the same hospital, patients treated by older physicians had
higher mortality than patients cared for by younger physicians, except those phy-
sicians treating high volumes of patients.
Physician age and outcomes in elderly patients in hospital in the US: obser-
vational study.
BMJ
2017 May 16;357(xx)j1797, Y Tsugawa, JP Newhouse, AM
Zaslavsky, et al.
Lower risk of heart
failure and death in
patients initiated on
SGLT-2 inhibitors vs other
glucose-lowering drugs
Circulation
Take-home message
•
This study compared SGLT-2 inhibitors with other
glucose-lowering drugs with respect to cardio-
vascular risk reduction. The results revealed that
patients receiving SGLT-2 inhibitors, regardless of
the specific agent, had lower rates of cardiovas-
cular death and heart failure compared with those
receiving other glucose-lowering drugs.
•
The authors concluded that SGLT-2 inhibitors may
offer the class effect of cardiovascular risk reduc-
tion in patients with type 2 diabetes.
Abstract
BACKGROUND
Reduction in cardiovascular death and hospital-
ization for heart failure (HHF) was recently reported with the
sodium-glucose co-transporter-2 inhibitor (SGLT-2i) empagliflozin
in type 2 diabetes patients with atherosclerotic cardiovascular
disease. We compared HHF and death in patients newly initiated
on any SGLT-2i versus other glucose lowering drugs (oGLDs)
in six countries to determine if these benefits are seen in real-
world practice, and across SGLT-2i class.
METHODS
Data were collected via medical claims, primary care/
hospital records and national registries from the US, Norway,
Denmark, Sweden, Germany and the UK. Propensity score for
SGLT-2i initiation was used to match treatment groups. Hazard
ratios (HRs) for HHF, death and their combination were estimated
by country and pooled to determine weighted effect size. Death
data were not available for Germany.
RESULTS
After propensity matching, there were 309,056 patients
newly initiated on either SGLT-2i or oGLD (154,528 patients in
each treatment group). Canagliflozin, dapagliflozin, and empag-
liflozin accounted for 53%, 42% and 5% of the total exposure
time in the SGLT-2i class, respectively. Baseline characteris-
tics were balanced between the two groups. There were 961
HHF cases during 190,164 person-years follow up (incidence
rate [IR] 0.51/100 person-years). Of 215,622 patients in the US,
Norway, Denmark, Sweden, and UK, death occurred in 1334 (IR
0.87/100 person-years), and HHF or death in 1983 (IR 1.38/100
person-years). Use of SGLT-2i, versus oGLDs, was associated
with lower rates of HHF (HR 0.61; 95% CI 0.51-0.73; p<0.001);
death (HR 0.49; 95% CI 0.41-0.57; p<0.001); and HHF or death
(HR 0.54; 95% CI 0.48-0.60, p<0.001) with no significant heter-
ogeneity by country.
CONCLUSIONS
In this large multinational study, treatment with
SGLT-2i versus oGLDs was associated with a lower risk of HHF
and death, suggesting that the benefits seen with empagliflozin
in a randomized trial may be a class effect applicable to a broad
population of T2D patients in real-world practice (NCT02993614).
Lower risk of heart failure and death in patients initiated on
SGLT-2 inhibitors versus other glucose-lowering drugs: the
CVD-REAL study.
Circulation
2017 May 18;[EPub Ahead of Print],
M Kosiborod, MA Cavender, AZ Fu, et al.
This mortality difference is not present if the
physician cares for a high volume of patients.
EDITOR’S PICKS
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VOL. 2 • NO. 1 • 2017